A basic introduction to fixed-effect and random-effects models for meta-analysis

The link between anxiety and theory of mind in children: A meta-analysis

BACKGROUND

The ability to reason about someone else's mental states, an ability known as theory of mind, is essential to help children navigate social life. However, not all children are socially skilled. Given socialisation is key for healthy development in children, finding what might exacerbate these difficulties is important. Emerging research suggests a potential link between anxiety and theory of mind abilities in children. This meta-analysis aims to characterise that link.

METHOD

Four electronic databases were systematically searched to identify relevant studies. Search terms included variations of terms for theory of mind, anxiety, and children. Studies were screened with inclusion and exclusion criteria for eligibility and identified papers were appraised on quality.

RESULTS

The search returned 3674 papers of which 20 were included in the analysis. These included a total of 3110 participants, aged 4-19. Overall, it was found that anxiety had a negative relationship with theory of mind and this appeared to be more pronounced in theory of mind processes related to affective states. There were no differences in the negative relationship between subtypes of anxiety or between studies with autistic and neurotypical children.

CONCLUSION

The findings suggest that anxious children may have difficulties using theory of mind abilities. Heterogeneity was substantial in the data, which limits the confidence in conclusions. Quality appraisal identified that the quality of theory of mind and anxiety measures varied between studies.

Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population

BACKGROUND

Subthreshold anxiety may act as a critical precursor and risk factor for the onset of threshold anxiety. However, accurate prevalence rates of subthreshold anxiety and its role in leading to threshold anxiety require further elucidation.

METHODS

We conducted a search on PubMed and Web of Science using predefined criteria and identified 45 articles with a total of 278,971 individuals to estimate the prevalence rates using a random effects model. The incidence risk ratio (IRR) was estimated by comparing the proportion of individuals with subthreshold anxiety who developed threshold anxiety to those without subthreshold anxiety in seven articles involving 18,693 individuals.

RESULTS

Our analysis revealed an overall prevalence of subthreshold anxiety of 6.19%. Specifically, among individuals with subthreshold generalized anxiety disorders, adolescents show the highest prevalence (9.47%), outpacing adults (4.69%) and the elderly (3.49%). Further analysis of seven studies showed an increased risk of developing threshold anxiety in individuals with subthreshold anxiety (IRR = 2.63), with a higher transition rate (9.59%) compared to those without subthreshold anxiety (3.65%).

CONCLUSIONS

Anxiety disorders may be conceptualized as a spectrum, with subthreshold anxiety serving as a significant prodromal state and risk factor for the development of threshold anxiety. Proactive management of subthreshold anxiety represents an effective approach for the prevention of its progression to threshold anxiety. Future research should investigate the risk of progression from subthreshold to threshold anxiety across various types, and explore how factors, such as social support and personality traits facilitate this progression.

Inflammatory bowel disease and white matter microstructure: A bidirectional Mendelian randomization study

BACKGROUND

Observational studies have reported changes in the brain white matter (WM) microstructure in patients with inflammatory bowel disease (IBD); however, it remains uncertain whether the relationship between them is causative. The aim of this study is to reveal the potential causal relationship between IBD and WM microstructure through a bidirectional two-sample Mendelian randomization (MR) analysis.

METHODS

We extracted genome-wide association study (GWAS) summary statistics for IBD and WM microstructure from published GWASs. Two-sample MR analysis was conducted to explore the bidirectional causal associations between IBD and WM microstructure, followed by a series of sensitivity analyses to assess the robustness of the results.

RESULTS

Although forward MR analysis results showed no evidence of causality from microstructural WM to IBD, reverse MR showed that genetically predicted IBD, consisting of ulcerative colitis and Crohn's disease, has a significant causal effect on the orientation dispersion index (OD) of the right tapetum (β = -0.029, 95% CI = -0.045 to -0.013, p = 3.63 × 10-4). Further sensitivity analysis confirmed the robustness of the association.

CONCLUSION

Our results suggested the potentially causal association of IBD with reduced OD in the right tapetum.

Mortality and morbidity risks associated with floods: A systematic review and meta-analysis

BACKGROUND

Flood disasters are projected to increase in severity, duration, and frequency in the context of climate change, and the risks of mortality and morbidity may increase after floods, which will overwhelm health systems.

OBJECTIVE

This study aims to synthesize current epidemiological evidence about the impacts of floods on mortality and morbidity.

METHOD

After performing a systematic literature search from 2000 to 2023, we included studies involving human participants, with exposures of floods, and with outcomes of mortality or morbidity.

RESULTS

In total, 37 studies were included in evidence syntheses. Meta-analyses yielded an overall relative risk of 1.26 (95% confidence interval [CI]: 1.10, 1.46), 1.10 (1.08, 1.13), 1.11 (1.04, 1.20), and 1.38 (1.18, 1.62) for all-cause mortality and morbidities of overall gastrointestinal diseases, diarrhea diseases, and dysentery, respectively. Although meta-analyses were not conducted, evidence from at least three studies consistently supported that exposure to floods was associated with increased risks of malaria and respiratory diseases. The evidence for other outcomes was reported but either limited or uncertain.

CONCLUSION

This study suggests that exposure to floods is associated with increased risks of all-cause mortality and morbidities of overall gastrointestinal diseases, diarrhea diseases, dysentery, malaria, and respiratory diseases, while further research is urgently called.

Gait Velocity Alterations in Essential Tremor: a Meta-Analysis

Essential tremor (ET) is a prevalent movement disorder that impairs gait function, including gait speed - a critical marker of mobility disability and adverse outcomes. This meta-analysis aimed to quantify differences in gait speed between individuals diagnosed with ET compared to people without a movement disorder diagnosis. Electronic databases were searched for studies comparing gait speed in ET patients and controls. Effect sizes were calculated using standardized mean differences (Hedges' g) and pooled using a random-effects model. Eight studies (390 ET, 227 controls) were included. ET patients exhibited significantly slower gait speeds than controls. The effect size (Hedges' g = -1.06, 95% CI -1.47 to -0.65, p < .001) indicates a large, clinically significant difference. Substantial study heterogeneity was observed (I2 = 76.9%). These findings suggest that gait speed deficits are a significant feature of ET, potentially reflecting cerebellar dysfunction. This highlights the need for gait assessment and targeted interventions in ET management to reduce fall risk and improve quality of life. Understanding the moderating factors such as medication type and state, disorder severity, and age could provide significant benefits in the treatment and management of ET.

Stemmed VS stemless total shoulder arthroplasty: a systematic review and meta-analysis

AIM

Anatomic total shoulder arthroplasty (TSA) is commonly used for glenohumeral osteoarthritis (OA) in patients with an intact rotator cuff. The aim of this study was to quantify advantages and disadvantages of the stemmed and stemless designs in terms of clinical outcome and complications.

METHODS

A review was developed based on the PRISMA statement and registered on PROSPERO. Inclusion criteria were comparative studies analyzing stemmed vs. stemless TSA in adults with OA. The literature search was performed in PubMed, Web of Science, and Wiley Cochrane Library up to January 2024. Constant and Murley Score (CMS), Range of Motion, and operative time were documented, as well as complications divided into minor and major complications. The Downs and Black's "Checklist for Measuring Quality" was used to assess risk of bias and quality of evidence.

RESULTS

Out of 1876 articles retrieved; 14 were included in the meta-analysis for a total of 1496 patients (51.4% men, 48.6% women). The CMS was 74.8 points in the stemmed group and 76.9 points in the stemless group, with no differences in both overall score and subscales. No differences were found in elevation and abduction, while external rotation was 3.9° higher in the stemless group (p < 0.05) No differences were found in operating time and overall complications. However, deep infections were higher in the stemless group (2.2% vs. 0.8%, p < 0.05). The quality was assessed as poor, fair, good, and excellent in 0, 2, 7, and 5 studies, respectively.

CONCLUSION

Stemless TSA may offer minor advantages in terms of external rotation, although the clinical relevance appears doubtful. On the other hand, a lower deep infection rate was documented for stemmed implants. Overall, stemmed and stemless TSA provided good clinical results, with similar benefits in terms of clinical outcomes and complications.

Personality disorders, violence and antisocial behaviour: updated systematic review and meta-regression analysis

BACKGROUND

Links between personality disorders and antisocial outcomes has not examined individual personality disorders, and the contribution of comorbidities remain uncertain. Previous systematic reviews are dated.

AIMS

To synthesise evidence from observational studies on the risk of antisocial outcomes and recidivism associated with personality disorders.

METHOD

We searched six bibliographic databases (up to March 2024) for observational studies examining the risk of antisocial behaviour, interpersonal violence and recidivism in individuals diagnosed with personality disorders, compared to controls. We explored sources of heterogeneity using subgroup analyses and meta-regression.

RESULTS

We identified 21 studies involving 83 418 individuals with personality disorders from 10 countries examining antisocial and violent outcomes (Aim 1), and 39 studies of 14 131 individuals from 13 countries with recidivism (or repeat offending) as the outcome (Aim 2). We found increased risks of violence among individuals with any personality disorder (odds ratio 4.5, 95% CI 3.0-6.7), particularly antisocial personality disorder (odds ratio 7.6, 95% CI 5.1-11.5) and borderline personality disorder (odds ratio 2.6, 95% CI 1.8-3.9). Individuals with any personality disorder (odds ratio 2.3, 95% CI 2.0-2.6) and antisocial personality disorder (odds ratio 2.8, 95% CI 1.6-4.9) also demonstrated an elevated risk of recidivism. Personality disorder types and comorbid substance use disorder were associated with between-study heterogeneity.

CONCLUSIONS

The assessment and management of personality disorders should be considered as part of violence prevention strategies. Improving identification and treatment of comorbid substance misuse may reduce adverse outcomes in individuals with personality disorders.

Evaluating meta-analysis as a replication success measure

BACKGROUND

The importance of replication in the social and behavioural sciences has been emphasized for decades. Various frequentist and Bayesian approaches have been proposed to qualify a replication study as successful or unsuccessful. One of them is meta-analysis. The focus of the present study is on the way meta-analysis functions as a replication success metric. To investigate this, original and replication studies that are part of two large-scale replication projects were used. For each original study, the probability of replication success was calculated using meta-analysis under different assumptions of the underlying population effect when replication results were unknown. The accuracy of the predicted overall replication success was evaluated once replication results became available using adjusted Brier scores.

RESULTS

Our results showed that meta-analysis performed poorly when used as a replication success metric. In many cases, quantifying replication success using meta-analysis resulted in the conclusion where the replication was deemed a success regardless of the results of the replication study.

DISCUSSION

We conclude that when using meta-analysis as a replication success metric, it has a relatively high probability of finding evidence in favour of a non-zero population effect even when it is zero. This behaviour largely results from the significance of the original study. Furthermore, we argue that there are fundamental reasons against using meta-analysis as a metric for replication success.

Transformation in marginal zone lymphoma: results from a prospective cohort and a meta-analysis of the literature

ABSTRACT

Marginal zone lymphoma (MZL) includes extranodal MZL (EMZL), splenic MZL (SMZL), and nodal MZL (NMZL) subtypes. Histologic transformation (HT) to large B-cell lymphomas is well documented but with a large variability in published cumulative incidence rates. We report results from the Molecular Epidemiology Resource (MER) cohort on the cumulative incidence of HT (with death as competing risk) and the associated risk factors and outcomes. We also conducted a meta-analysis of available studies on the cumulative incidence of HT. From 2002 to 2015, 529 patients with MZL were enrolled in the MER study (69% EMZL, 16% SMZL, and 15% NMZL). The 10-year overall survival (OS) from diagnosis was 66%. HT occurred in 21 patients with a 5-year and 10-year cumulative incidence of 2.7% (95% confidence interval [CI], 0.02-0.05) and 3.6% (95% CI, 0.02-0.06), respectively. HT was associated with an increased risk for death (subdistribution hazard ratio [HR], 3.95; 95% CI, 2.06-7.55). Predictors of HT were ≥2 extranodal sites and mucosa-associated lymphoid tissue International Prognostic Index score ≥2. The OS was 79% at 5 years and 55% at 10 years after HT. In the meta-analysis of 12 studies (6161 patients), the 5- and 10-year cumulative incidence of HT across all subtypes were 5% (95% CI, 0.05-0.06) and 8% (95% CI, 0.07-0.09), respectively. These rates were lower in EMZL (3% and 5%) than in SMZL (7% and 13%) and NMZL (9% and 13%). Although HT is relatively uncommon in the first decade after MZL diagnosis, it is associated with an inferior outcome and needs new approaches for prevention and management.

TRIB3 overexpression predicts malignant progression and poor prognosis in human solid tumors: bioinformatics validation and clinical significance

INTRODUCTION

Overexpression of tribbles homolog 3 (TRIB3) has been reported in various cancers, yet its clinical significance remains contentious. This study aims to elucidate the association between TRIB3 overexpression and the progression and prognosis of solid tumors.

METHODS

A comprehensive analysis was conducted using data from published studies and The Cancer Genome Atlas (TCGA) up to May 2023. We evaluated the impact of high TRIB3 expression on tumor malignancy and survival outcomes across different cancer types.

RESULTS

Seventeen studies met the inclusion criteria. Our findings revealed that TRIB3 overexpression is significantly associated with increased distant metastasis (OR = 4.01, 95% CI: 2.36-6.74, p < 0.001) and advanced histological stage (OR = 2.68, 95% CI: 1.50-4.78, p < 0.001). Additionally, high TRIB3 expression significantly elevated the risk of reduced overall survival (OS) in cancer patients (HR = 1.52, 95% CI: 1.05-2.20, p < 0.001), indicating a poor prognosis. Analyses of TCGA data among various prognostic indicators corroborated these findings.

CONCLUSIONS

TRIB3 overexpression is significantly linked to malignant progression and unfavorable prognosis in diverse solid tumors. These results suggest that TRIB3 holds promise as a biomarker and therapeutic target in human cancers.

Are trauma-related beliefs associated with psychosis symptoms? A systematic review and meta-analysis

Trauma-related beliefs are theorized to contribute to the development and maintenance of psychosis symptoms. However, the evidence for this proposal has yet to be systematically reviewed. This article is the first to synthesize and meta-analyze studies examining associations between trauma-related beliefs and psychosis symptoms, including hallucinations, delusions, paranoia, and negative symptoms. A systematic database search of Medline, PsychINFO, Embase, Web of Science, CINHAL, and Cochrane identified a total of 15 articles that met the inclusion criteria for systematic review and 11 articles which met the inclusion criteria for meta-analysis. Separate random-effects meta-analyses were conducted for each psychosis symptom. Meta-analytic findings demonstrated a small to moderate association between trauma-related beliefs and hallucination severity (k = 7, r = 0.25, 95% CI 0.10-0.39), a moderate to large association with delusion severity (k = 8, r = 0.43, 95% CI 0.31-0.54), and large association with paranoia severity (k = 4, r = 0.58, 95% CI 0.49-0.66). Narrative synthesis findings indicate that evidence for an association between negative symptoms and trauma-related beliefs was inconclusive. The meta-analytic findings provide support for an association between trauma-related beliefs and positive psychosis symptoms. This provides evidence suggesting trauma therapies for psychosis that target these beliefs may improve distressing psychosis. However, further research adopting longitudinal designs and controlling for confounders is required to better establish causality, including mediation analysis of therapy trials.

Effectiveness of chatbot-based interventions on mental well-being of the general population in Asia: protocol for a systematic review and meta-analysis of randomised controlled trials

INTRODUCTION

In Asian countries, stigma against psychiatric disorders and shortage of manpower are the two major challenges that hinder people from receiving treatments. Chatbots can surely help people surpass the stigmatising and manpower shortage challenges. Since a comprehensive review in the Asian context is lacking, this systematic review will evaluate the effects of chatbot interventions on the mental well-being of the general population in Asia.

METHODS AND ANALYSIS

Four electronic databases (PubMed, CINAHL, PsycINFO and MEDLINE) will be searched until December 2024. Randomised controlled trials with English/Chinese full text available will be included. Random-effect models will be used for meta-analyses. The risk of bias (RoB) and certainty of evidence across studies will be assessed using the Cochrane RoB2 and Grading of Recommendation Assessment, Development and Evaluation tools, respectively.

ETHICS AND DISSEMINATION

This study will not require ethical approval. The findings will be disseminated through peer-reviewed publications.

FUNDING

School Research Grant of the Tung Wah College (2023-04-52-SRG230401) PROSPERO REGISTRATION NUMBER: CRD42024546316.

Bloodletting at the ear apex for acute stroke: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Stroke is a major cause of death and disability worldwide. Despite innovative developments in acute stroke treatment techniques in modern society, many stroke survivors still experience complications, leading to a demand for complementary and alternative medicines, including traditional medicine. Bloodletting at the ear apex (BLEA) is a nonpharmacological intervention used for various diseases, including acute stroke, in traditional medicine in East Asian countries, including China and Korea. This study aimed to evaluate the clinical efficacy of BLEA for acute stroke recovery.

METHODS

We searched PubMed, Embase, CENTRAL, AMED, CNKI, KoreaMed, ScienceOn, and OASIS databases for randomized controlled trials (RCTs) evaluating the effect of BLEA on acute stroke recovery. We systematically reviewed the literature published in academic journals up to September 8, 2024 and synthesized the data extracted from the final selected literature. The results of the meta-analysis are presented as mean differences (MDs) with 95% confidence intervals (CIs). The Cochrane Risk of Bias 2 tool and GRADE methodology were used for quality assessment.

RESULTS

Six RCTs with 530 participants were included in this meta-analysis. In patients with acute stroke receiving conventional Western medical treatment, the addition of BLEA significantly improved neurological deficits assessed by the National Institute of Stroke Scale (MD, -2.83; 95% CIs, -4.48 to -1.17), consciousness impairment measured by the Glasgow Coma Scale (MD, 2.75. 95% CIs, 1.72 to 3.78), and motor function assessed by the Fugl-Meyer Assessment (MD, 5.31. 95% CIs, 3.04 to 7.58). It also significantly reduced the length of hospital stay (MD, -7.39; 95% CIs. -8.85 to -5.93).

CONCLUSION

BLEA may be a promising intervention that provides additional benefits to patients with acute stroke receiving standard western medical care. However, the supporting evidence comes from a few small studies with a high risk of bias and low reporting quality. Future studies with appropriate population sizes and more rigorous methodology are warranted.

Minimally Invasive Versus Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Trial Sequential Analysis of Randomized Trials

BACKGROUND

Minimally invasive distal gastrectomy (MIDG) has been shown to be associated with improved short-term outcomes compared to open distal gastrectomy (ODG) in patients with locally advanced gastric cancer (LAGC). The impact of MIDG on long-term patient survival remains debated. Aim was to compare the MIDG vs. ODG effect on long-term survival.

METHODS

Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). Web of Science, Scopus, MEDLINE, the Cochrane Central Library, and ClinicalTrials.gov were queried. Hazard ratio (HR) and 95% confidence intervals (CI) were used as pooled effect size measures. Five-year overall (OS) and disease-free survival (DFS) were primary outcomes.

RESULTS

Five RCTs were included (2835 patients). Overall, 1421 (50.1%) patients underwent MIDG and 1414 (49.9%) ODG. The ages ranged from 48 to 70 years and 63.4% were males. The pooled 5-year OS (HR = 0.86; 95% CI 0.70-1.04; I2 = 0.0%) and 5-year DFS (HR = 1.03; 95% CI 0.87-1.23; I2 = 0.0%) were similar for MIDG vs. ODG. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus suggesting not conclusive 5-year OS and DFS results because the total information size was not sufficient.

CONCLUSIONS

MIDG and ODG seem to have equivalent 5-year OS and DFS in patients with LAGC. However, the cumulative evidence derived from the TSA showed that the actual information size is not sufficient to provide conclusive data.

Microplastics stimulated soil bacterial alpha diversity and nitrogen cycle: A global hierarchical meta-analysis

Microplastics (MPs) pollution is recognized as a global emerging threat with serious potential impacts on ecosystems. Our meta-analysis was conducted based on 117 carefully selected publications, from which 2160 datasets were extracted. These publications described experiments in which MPs were added to soil (in laboratory or greenhouse experiments or in the field) after which the soil microbial community was analyzed and compared to a control group. From these publications, we extracted 1315 observations on soil bacterial alpha diversity and richness indices and 845 datasets on gene abundance of bacterial genes related to the soil nitrogen cycle. These data were analyzed using a multiple hierarchical mixed effects meta-analysis. The mean effect of microplastic exposure was a significant decrease of soil bacterial community diversity and richness. We explored these responses for different regulators, namely MPs addition rates, particle size and plastic type, soil texture and land use, and study type. Of the bacterial processes involved in the soil nitrogen cycle, MPs addition significantly promoted assimilation of ammonium, nitrogen fixation and urea decomposition, but significantly inhibited nitrification. These results suggest that MPs contamination may have considerable impacts on soil bacterial community structure and function as well as on the soil nitrogen cycle.

Shifting reliance between the internal and external world: A meta-analysis on visual-working memory use

Visual working memory (VWM) is a fundamental cognitive capacity that allows us to temporarily hold visual information, but storage is effortful and content-fragile. Rather than loading VWM to the maximum, individuals usually rely on the external world and access information just in time. However, participants do rely on VWM more as access costs to external information increase. This phenomenon is commonly investigated with so-called copy tasks, which differ across paradigms, manipulations, and dependent variables. We here present findings of a meta-analysis into the reliability and consistency of shifts in the assumed trade-off between storing and sampling across manipulations and dependent variables, using data from 28 experiments. We found that all cost manipulations led to substantial shifts from external sampling to storage in VWM. Cost manipulations did not differ in their effect across studies even though such differences are reported within studies. All dependent variables were associated with clear but different strong effects. We argue that the differences observed between indicators are not only due to sensitivity differences but also due to differential aspects of behavior that are measured. New variables and techniques might now pave the way to understanding the trade-off between storing and sampling more in-depth. Collectively, our findings suggest that the reliance on VWM or the external world shifts consistently as access cost is increased, is largely irrespective of cost manipulations, and expresses itself reliably across dependent variables. With this work, we seek to help establish standards and comparability across this growing body of work.

A systematic review and meta-analysis of physical exercise non-adherence and its determinants among type 2 diabetic patients in Ethiopia

INTRODUCTION

Physical exercise non-adherence is one of the leading risk behavioral factors for type two diabetic patients and one of the leading causes of mortality of patients worldwide. Therefore, the current study was conducted to determine the pooled prevalence and its determinants of non-adherence to physical exercise among type two diabetes adult patients in Ethiopia.

METHODS

Studies were searched systematically using International databases from PubMed, Google Scholar, Cochrane Library, Embase, and CINAHL. The quality of articles that were searched was assessed using the New Castle Ottawa scale for a cross-sectional study design. Statistical analysis was performed using STATA version 14 and a meta-analysis was carried out using a random effect model method. Assessment of the certainty evidence's was done by applying the GRADE method. The Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline was followed for reporting results. The title and the protocol of this meta-analysis were registered at the online database PROSPERO registration number CRD42023430579.

RESULT

From the total 1711 records screened, 7 studies with 3437 participants who fulfilled the inclusion criteria were included in this systematic review. The estimated pooled prevalence of exercise non-adherence in Ethiopia was 50.59%. Being female (OR = 1.27, 95% CI (1.82, 1.97)), primary level education (OR = 1.19, 95% CI (1.01, 1.39)) and rural residency (OR = 4.87, 95% CI (2.80, 8.48)) were significantly associated with exercise non-adherence.

CONCLUSION

According to papers evaluated by the GRADE assessment the certainty of evidence's was poor. More than half of the diabetes patients had physical exercise non-adherence. Strategies such as emotional support, health education, and emphasis on rural diabetic patients can improve the problem of non-adherence.

Comparison of vasopressors for management of hypotension in high-risk caesarean section under neuraxial anesthesia: a systematic review and network meta-analysis

BACKGROUND

Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation.

METHODS

We compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models.

RESULTS

We analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable.

CONCLUSIONS

Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery.

TRIAL REGISTRATION

This systematic review was registered at PROSPERO (CRD42023397259).

Therapeutic Effects of Umbilical Cord Serum for Dry Eye Disease: A Systemic Review and Meta-Analysis

INTRODUCTION

Dry eye disease (DED) is a prevalent ocular condition that significantly impacts quality of life. Umbilical cord serum (UCS) has emerged as a promising therapeutic option, but its efficacy requires further investigation. This systemic review and meta-analysis aimed to evaluate the therapeutic effects of UCS eye drops in the treatment of DED.

METHODS

A comprehensive literature search was conducted across multiple databases, including PubMed, Web of science, Embase, Science Direct, Cochrane Library, and China National Knowledge Network, to identify relevant clinical trials. The efficacy of UCS was assessed based on key outcome measures, such as the ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer I test, and corneal fluorescein staining scores. Meta-analyses were performed to pool the results, and the findings were presented in a forest plot.

RESULTS

Eight studies were included in the meta-analysis, with two relevant randomized controlled trials (RCTs) involving a total of 204 patients. Most of the included studies had a follow-up time of less than 2 months. The pooled results showed that UCS treatment significantly improved the OSDI, with a mean difference (MD) of -9.16 (95% confidence interval [CI], -12.0, -6.36) compared to baseline. Additionally, the TBUT values were higher in the UCS group, with an MD of 2.65 (95% CI, 0.93, 4.36). The Schirmer I test results showed an improvement, with an MD of 1.18 (95% CI, 0.30, 2.06). The fluorescein staining score were also lower in the UCS treatment group, with an MD of -4.71 (95% CI, -5.72, -3.69).

CONCLUSION

This meta-analysis suggested that UCS eye drops had a beneficial therapeutic effect on DED, significantly improving the OSDI, TBUT, Schirmer I test, and corneal fluorescein staining scores. However, larger RCTs with longer follow-up periods were needed to further evaluate the long-term efficacy and safety of UCS in the management of DED.

Efficacy and safety of oral propranolol and topical timolol in the treatment of infantile hemangioma: a meta-analysis and systematic review

BACKGROUND

Propranolol, a nonselective β-blocker, is the first-line treatment for infantile hemangioma (IH). Topical timolol has recently been proposed as a novel IH treatment with fewer adverse effects. This study was conducted to compare the efficacy and safety of oral propranolol and topical timolol for treating IH.

METHODS

Studies were included after searching PubMed, Embase, Web of Science, and the Cochrane Library via the keywords of "propranolol", "timolol", "infantile hemangioma" and their synonyms. A meta-analysis with pooled odds ratios was performed using the fixed-effect model.

RESULTS

Seven articles with 2071 patients were included in this meta-analysis. Compared with topical timolol, oral propranolol had a greater response rate (OR = 2.12, P < 0.001), but it was also associated with a greater risk of adverse events (OR = 2.31, P < 0.001). For superficial IH, timolol demonstrated similar efficacy to propranolol (OR = 1.28, P = 0.34) but with fewer adverse events (OR = 2.30, P = 0.001). Additionally, compared with topical timolol, propranolol at a dosage of 2 mg/kg/d had a better response rate (OR = 2.62, P < 0.001), whereas the 1.0∼1.5 mg/kg/d propranolol group showed no significant difference (OR = 1.34, P = 0.38).

CONCLUSION

Oral propranolol presents superior therapeutic efficacy in the treatment of IH compared to topical timolol. However, topical timolol can serve as an alternative to oral propranolol for treating superficial IH, providing similar efficacy with fewer adverse effects. Additionally, propranolol at a dosage of 2 mg/kg/d offers greater efficacy with a comparable safety profile, whereas the 1.0∼1.5 mg/kg/d propranolol dosage shows no significant difference in efficacy compared to timolol but is associated with more adverse events.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024603724, identifier CRD42024603724.

The impact of coffee consumption on osteoarthritis: insights from NHANES and Mendelian randomization analysis

Background

Osteoarthritis (OA) is a prevalent degenerative joint condition, and emerging evidence suggests that dietary factors, such as coffee consumption, may influence its risk. However, the relationship between coffee consumption and the risk of developing OA remains ambiguous. This study aims to explore the association between coffee intake and OA complemented by Mendelian randomization (MR) to infer causality.

Materials and methods

We analyzed data from 32,439 participants across 10 NHANES cycles (1999-2018), including 3,676 individuals diagnosed with OA. Osteoarthritis was diagnosed through a structured questionnaire, while coffee consumption was assessed via 24-h dietary recalls. Participants were categorized based on reported coffee intake: 0 cups, <2 cups, 2-4 cups, and >4 cups per day. We employed weighted multivariable logistic regression to examine associations between coffee consumption and OA by using data from the NHANES 1999-2018, adjusting for various covariates. Subsequently, a MR analysis was conducted using genetic variants as instrumental variables to infer causal relationships, with multiple methods including inverse-variance weighted (IVW) analysis, MR-Egger regression, and weighted median techniques to assess the robustness, heterogeneity, and potential pleiotropy of our findings.

Results

Our regression models indicated an increased risk of OA with rising coffee consumption, with significant associations noted particularly for those consuming more than 4 cups daily (OR = 1.19, 95% CI: 1.00-1.41, p = 0.049). In MR analysis, coffee intake was causally linked to OA types, demonstrating increased risk for knee OA (KOA: OR = 1.60, 95% CI: 1.08-2.35, p = 0.018), hip OA (HOA: OR = 1.85, 95% CI: 1.06-3.25, p = 0.031), and combined KOA and HOA (KHOA: OR = 1.66, 95% CI: 1.18-2.33, p = 0.003). Sensitivity analyses confirmed the stability of results across multiple evaluation methods.

Conclusion

Our findings highlight a significant association between coffee consumption and an increased risk of OA, suggesting that higher intake levels may contribute to OA morbidity. These results warrant further exploration into the underlying biological mechanisms and implications for dietary guidelines in populations at risk for OA.

Fertility-preserving treatment for stage IA endometrial cancer: a systematic review and meta-analysis

OBJECTIVE

The increasing use of fertility-preserving treatments in reproductive-aged patients with early-stage endometrial cancer necessitates robust evidence on the effectiveness of oral progestins and levonorgestrel-releasing intrauterine device. We conducted a systematic review and meta-analysis to examine the outcomes following these 2 primary progestin-based therapies in reproductive-aged patients with early-stage endometrial cancer.

DATA SOURCES

We conducted a systematic review of observational studies and randomized controlled trials following the Cochrane Handbook guidance. We conducted a literature search of 5 databases and 1 trial registry from inception of the study to April 16, 2024.

STUDY ELIGIBILITY CRITERIA

Studies reporting complete response within 1 year in reproductive-aged patients with clinical stage IA endometrioid cancer undergoing progestin therapy treatment were included. We used data from both observational and randomized controlled studies.

STUDY APPRAISAL AND SYNTHESIS METHODS

The primary exposure assessed was the type of progestational treatment (oral progestins or LNG-IUD). The primary outcome was the pooled proportion of the best complete response (CR) within 1 year of primary progestational treatment. We performed a proportional meta-analysis to estimate the treatment response. Sensitivity analyses were performed by removing studies with extreme effect sizes or removing grade 2 tumors. The risk of bias was assessed in each study using the Joanna Briggs Institute critical appraisal checklist.

RESULTS

Our analysis involved 754 reproductive-aged patients diagnosed with endometrial cancer, with 490 receiving oral progestin and 264 receiving levonorgestrel-releasing intrauterine device as their primary progestational treatment. The pooled proportion of the best complete response within 12 months of oral progestin and levonorgestrel-releasing intrauterine device treatment were 66% (95% CI, 55-76) and 86% (95% CI, 69-95), respectively. After removing outlier studies, the pooled proportion was 66% (95% CI, 57-73) for the oral progestin group and 89% (95% CI, 75-96) for the levonorgestrel-releasing intrauterine device group, showing reduced heterogeneity. Specifically, among studies including grade 1 tumors, the pooled proportions were 66% (95% CI, 54-77) for the oral progestin group and 83% (95% CI, 50-96) for the levonorgestrel-releasing intrauterine device group. The pooled pregnancy rate was 58% (95% CI, 37-76) after oral progestin treatment and 44% (95% CI, 6-90) after levonorgestrel-releasing intrauterine device treatment.

CONCLUSION

This meta-analysis provides valuable insights into the effectiveness of oral progestins and levonorgestrel-releasing intrauterine device treatment within a 12-month timeframe for patients with early-stage endometrial cancer who desire to preserve fertility. These findings have the potential to assist in personalized treatment decision-making for patients.

The relationship between emotional intimate partner violence and other forms of violence: A metaanalytic review

The present study aimed to explore the relationship between emotional intimate partner violence (IPV) and different forms of violence (e.g., stalking perpetration and victimization, physical IPV perpetration and victimization, sexual IPV perpetration and victimization, and controlling behaviors) using a meta-analysis. Data from 188 studies, yielding 382 effect sizes, were used to compare the strength of correlates for IPV victimization versus perpetration, as well as gendered results. This meta-analysis found, in order of strength, controlling behaviors victimization, physical IPV victimization, physical IPV perpetration, sexual IPV victimization, stalking victimization, and sexual IPV perpetration were significantly associated with emotional IPV victimization. The meta-analysis also found, in order of strength, emotional IPV perpetration was positively associated with stalking perpetration, physical IPV perpetration, causing injury to a partner, controlling behaviors victimization, sexual IPV perpetration, physical IPV victimization, controlling behaviors perpetration, and sexual IPV victimization. This study found limited significant differences around gender, with physical IPV victimization approaching significance for emotional IPV perpetration for women. The current study highlights the implications associated with early assessment and intervention in cases of IPV.

Does socioeconomic position moderate the associations between the content and delivery features of digital behaviour change interventions for smoking cessation and intervention effectiveness? A systematic review and meta-analysis

Prior research indicates that digital smoking cessation interventions can be effective, but little is known about their active ingredients. Therefore, this review aimed to examine the associations of content (behaviour change techniques [BCTs]), delivery features (delivery mode, readability, ease-of-use), and socioeconomic position with effectiveness. Systematic searches and hand searches were conducted from February to June 2023 to identify experimental evaluations of digital smoking cessation interventions published since 2004. Random-effects meta-analyses were used to explore intervention effectiveness. Meta-CART were used to explore whether content, delivery features, or socioeconomic position moderate effectiveness and assessed interactions between potential moderators. Meta-regressions were performed as sensitivity checks. For k = 29 studies (n = 42,662), the authors provided sufficient data and materials for inclusion in the primary analyses. Participants in the intervention groups had greater odds of successfully quitting smoking (OR = 1.29, 95% CI: 1.10-1.51, p = .002) with similar effect sizes across socioeconomic groups (ORlow SEP = 1.25, 95% CI: 1.00-1.57, p = .048; ORhigh SEP = 1.36, 95% CI: 1.06-1.76, p = .017). No delivery features were significantly associated with effectiveness. The BCT 'commitment' was associated with larger effects in populations with high, but not low, socioeconomic positions. There were no significant interactions between potential moderators. Digital smoking cessation interventions are effective across socioeconomic groups. Uncertainty around active ingredients remains.

Do Good Citizens Look to the Future? The Link Between National Identification and Future Time Perspective and Their Role in Explaining Citizens' Reactions to Conflicts Between Short-Term and Long-Term National Interests

When people consider what is good for their country, they might face a conflict between the country's short-term and long-term interests. We suggest that resolving this conflict depends on people's form of national identification and future time perspective. Across four studies (N = 4,274), we showed that constructive patriotism, but not conventional patriotism or glorification, was positively associated with future time perspective. Moreover, we showed that this further translated into people's responses to intertemporal conflicts. Specifically, constructive patriotism was indirectly linked to higher support for national policies with long-term advantages (despite short-term disadvantages) and lower support for national policies with long-term disadvantages (despite short-term advantages), and these links were mediated by future time perspective. Overall, our results demonstrate that distinct forms of national identification are differently linked to future time perspective. Likewise, this helps explain differences in how much people care about their country's present and future.

The impact of tinnitus on speech perception in noise: a systematic review and meta-analysis

PURPOSE

Tinnitus is a condition that causes people to hear sounds without an external source. One significant issue arising from this condition is the difficulty in communicating, especially in the presence of noisy backgrounds. The process of understanding speech in challenging situations requires both cognitive and auditory abilities. Since tinnitus presents unique challenges, it is important to investigate how it affects speech perception in noise.

METHOD

In this review, 32 articles were investigated to determine the effect of tinnitus on the effect of speech in noise perception performance. Based on the meta-analysis performed using a random-effects model, meta-regression was used to explore the moderating effects of age and hearing acuity.

RESULTS

A total of 32 studies were reviewed, and the results of the meta-analysis revealed that tinnitus significantly impacts speech in terms of noise perception performance. Additionally, the regression analysis revealed that age and hearing acuity are not significant predictors of speech in noise perception.

CONCLUSION

Our findings suggest that tinnitus affects speech perception in noisy environments due to cognitive impairments and central auditory processing deficits. Hearing loss and aging also contribute to reduced speech in noise performance. Interventions and further research are necessary to address individual challenges associated with continuous subjective tinnitus.

The counteractive effects of interventions addressing mental fatigue on sport-specific performance among athletes: A systematic review with a meta-analysis

The deleterious consequences of mental fatigue (MF) on athletes in diverse sporting domains have been subject to extensive inquiry. However, the efficacy of interventions to counteract the effects of MF remains largely elusive. This review aims to evaluate the effects of counteractive interventions on the sport-specific performance of mentally fatigued athletes. Moreover, synthesizes the current evidence on which sports effectively counter the detrimental effects of MF with interventions, highlighting potential avenues for upcoming research. A systematic search was executed via Web of Science, Scopus, PubMed, and EBSCOhost, in addition to Google Scholar and references for grey literature. A meta-analysis was executed to compute effect sizes for different interventions with 13 qualified papers. Interventions include transcranial direct current stimulation, person-fit, mindfulness, glucose supplementation, caffeine mouth rinsing, and nature exposure showed potential to mitigate the detrimental effects on sport-specific performance, particularly in shooting accuracy (ES = 0.591; p = 0.001), decision-making accuracy (ES = 0.553; p = 0.006), and reaction time (ES = -0.871; p < 0.001), however, not in completion time (ES = -0.302; p = 0.182). This review underscores the unique roles of self-regulatory resources and directed attention. Nonetheless, a cautious interpretation of the findings is warranted given the paucity of investigations involving potential interventions in numerous other sports, such as volleyball, Australian football, cricket, and boxing.

Risk factors and incidence of central venous access device-related thrombosis in hospitalized children: a systematic review and meta-analysis

BACKGROUND

The risk factors for central venous access device-related thrombosis (CRT) in children are not fully understood. We used evidence-based medicine to find the risk factors for CRT by pooling current studies reporting risk factors of CRT, aiming to guide clinical diagnosis and treatment.

METHODS

A systematic search of PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, and Wanfang databases was conducted. RevMan 5.4 was employed for data analysis.

RESULTS

The review included 47 studies evaluating 262,587 children with CVAD placement. Qualitative synthesis and quantitative meta-analysis identified D-dimer, location of insertion, type of catheter, number of lumens, catheter indwelling time, and central line-associated bloodstream infection as the most critical risk factors for CRT. Primarily due to observational design, the quality of evidence was regarded as low certainty for these risk factors according to the GRADE approach.

CONCLUSION

Because fewer high-quality studies are available, larger sample sizes and well-designed prospective studies are still needed to clarify the risk factors affecting CRT. In the future, developing pediatric-specific CRT risk assessment tools is important. Appropriate stratified preventive strategies for CRT according to risk assessment level will help improve clinical efficiency, avoid the occurrence of CRT, and alleviate unnecessary suffering of children.

IMPACT

This is the latest systematic review of risk factors and incidence of CRT in children. A total of 47 studies involving 262,587 patients were included in our meta-analysis, according to which the pooled prevalence of CRT was 9.1%. This study identified several of the most critical risk factors affecting CRT in children, including D-dimer, insertion location, type of catheter, number of lumens, catheter indwelling time, and central line-associated bloodstream infection (CLABSI).

Revisiting the Prevalence of Unhealthy Alcohol Use Among Ethnic Minority Immigrant Gay, Bisexual Men, and Other Men Who Have Sex with Men in North America: A Systematic Review and Meta-analysis

Unhealthy alcohol use is a significant public health concern among ethnic minority immigrant gay, bisexual men, and other men who have sex with men (GBMSM) in North America. The definition of unhealthy alcohol use is any use that increases the risk of health consequences or has already led to negative health consequences. Despite its association with various health problems, this issue remains understudied in this population. Therefore, we aim to synthesize key findings to provide the prevalence of unhealthy alcohol use and related factors among this population in North America. We conducted a comprehensive literature search in multiple scientific databases to identify studies on alcohol use among ethnic minority immigrant GBMSM. Using random-effect modeling strategies, we aggregate and weigh the individual estimates, providing a pooled prevalence of unhealthy alcohol use within this population. Our review included 20 articles with 2971 participants (i.e., 53% were Latino, 45% were Asian/Pacific Islanders, and 2% were African). The meta-analysis revealed that 64% (95% CI 0.50, 0.78) of the participants reported recent alcohol use, while 44% (95% CI 0.30, 0.59) engaged in unhealthy alcohol use. Co-occurring health issues identified in the studies are other substance use (32%; 95% CI 0.21, 0.45), positive HIV status (39%; 95% CI 0.14, 0.67), and mental health issues (39%; 95% CI 0.21, 0.58). We also identified several factors associated with unhealthy alcohol use, including risky sexual behaviors, experiences of discrimination based on race and sexual orientation, and experiences of abuse. However, meta-regression results revealed no statistically significant associations between alcohol use and co-occurring health problems. This is the first study to systematically review unhealthy alcohol use among ethnic minority immigrant GBMSM. Despite the high burden of alcohol use, there is a dearth of research among Asian and African GBMSM. Our findings underscore the need for more research in these groups and provide insights to inform targeted clinical prevention and early intervention strategies to mitigate the adverse consequences of unhealthy alcohol use among ethnic minority immigrant GBMSM.

Are there interindividual differences in the reactive hypoglycaemia response to breakfast? A replicate crossover trial

BACKGROUND

Following consumption of a meal, circulating glucose concentrations can rise and then fall briefly below the basal/fasting concentrations. This phenomenon is known as reactive hypoglycaemia but to date no researcher has explored potential inter-individual differences in response to meal consumption.

OBJECTIVE

We conducted a secondary analysis of existing data to examine inter-individual variability of reactive hypoglycaemia in response to breakfast consumption.

METHODS

Using a replicate crossover design, 12 healthy, physically active men (age: 18-30 y, body mass index: 22.1 to 28.0 kg⋅m- 2) completed two identical control (continued overnight fasting) and two breakfast (444 kcal; 60% carbohydrate, 17% protein, 23% fat) conditions in randomised sequences. Blood glucose and lactate concentrations, serum insulin and non-esterified fatty acid concentrations, whole-body energy expenditure, carbohydrate and fat oxidation rates, and appetite ratings were determined before and 2 h after the interventions. Inter-individual differences were explored using Pearson's product-moment correlations between the first and second replicates of the fasting-adjusted breakfast response. Within-participant covariate-adjusted linear mixed models and a random-effects meta-analytical approach were used to quantify participant-by-condition interactions.

RESULTS

Breakfast consumption lowered 2-h blood glucose by 0.44 mmol/L (95%CI: 0.76 to 0.12 mmol/L) and serum NEFA concentrations, whilst increasing blood lactate and serum insulin concentrations (all p < 0.01). Large, positive correlations were observed between the first and second replicates of the fasting-adjusted insulin, lactate, hunger, and satisfaction responses to breakfast consumption (all r > 0.5, 90%CI ranged from 0.03 to 0.91). The participant-by-condition interaction response variability (SD) for serum insulin concentration was 11 pmol/L (95%CI: 5 to 16 pmol/L), which was consistent with the τ-statistic from the random-effects meta-analysis (11.7 pmol/L, 95%CI 7.0 to 22.2 pmol/L) whereas effects were unclear for other outcome variables (e.g., τ-statistic value for glucose: 0 mmol/L, 95%CI 0.0 to 0.5 mmol/L).

CONCLUSIONS

Despite observing reactive hypoglycaemia at the group level, we were unable to detect any meaningful inter-individual variability of the reactive hypoglycaemia response to breakfast. There was, however, evidence that 2-h insulin responses to breakfast display meaningful inter-individual variability, which may be explained by relative carbohydrate dose ingested and variation in insulin sensitivity of participants.

Machine learning to predict adverse drug events based on electronic health records: a systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to provide a comprehensive overview of the application of machine learning (ML) in predicting multiple adverse drug events (ADEs) using electronic health record (EHR) data.

METHODS

Systematic searches were conducted using PubMed, Web of Science, Embase, and IEEE Xplore from database inception until 21 November 2023. Studies that developed ML models for predicting multiple ADEs based on EHR data were included.

RESULTS

Ten studies met the inclusion criteria. Twenty ML methods were reported, most commonly random forest (RF, n = 9), followed by AdaBoost (n = 4), eXtreme Gradient Boosting (n = 3), and support vector machine (n = 3). The mean area under the summary receiver operator characteristics curve (AUC) was 0.76 (95% confidence interval [CI] = 0.26-0.95). RF combined with resampling-based approaches achieved high AUCs (0.9448-0.9457). The common risk factors of ADEs included the length of hospital stay, number of prescribed drugs, and admission type. The pooled estimated AUC was 0.72 (95% CI = 0.68-0.75).

CONCLUSIONS

Future studies should adhere to more rigorous reporting standards and consider new ML methods to facilitate the application of ML models in clinical practice.

Associations between insomnia and cardiovascular diseases: a meta-review and meta-analysis of observational and Mendelian randomization studies

STUDY OBJECTIVES

Observational studies suggest associations between insomnia and cardiovascular diseases (CVDs), but the causal mechanism remains unclear. We investigated the potential causal associations between insomnia and CVDs by a combined systematic meta-review and meta-analysis of observational and Mendelian randomization studies.

METHODS

We searched PubMed, Web of Science, and Embase for English-language articles from inception to July 11, 2023. Two reviewers independently screened the articles to minimize potential bias. We summarized the current evidence on the associations of insomnia with coronary artery disease, atrial fibrillation, heart failure, myocardial infarction, hypertension, and stroke risk by combining meta-analyses of observational and Mendelian randomization studies.

RESULTS

Four meta-analyses of observational studies and 9 Mendelian randomization studies were included in the final data analysis. A systematic meta-review of observational studies provided strong evidence that insomnia is an independent risk factor for many CVDs, including atrial fibrillation, myocardial infarction, and hypertension. A meta-analysis of Mendelian randomization studies revealed that insomnia may be potentially causally related to coronary artery disease (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.10-1.19, I2 = 97%), atrial fibrillation (OR = 1.02, 95% CI = 1.01-1.04, I2 = 94%), heart failure (OR = 1.04, 95% CI = 1.03-1.06, I2 =97%), hypertension (OR = 1.16, 95% CI = 1.13-1.18, I2 = 28%), large artery stroke (OR = 1.14, 95% CI = 1.05-1.24, I2 = 0%), any ischemic stroke (OR = 1.09, 95% CI = 1.03-1.14, I2 = 60%), and primary intracranial hemorrhage (OR = 1.16, 95% CI = 1.05-1.27, I2 = 0%). No evidence suggested that insomnia is causally associated with cardioembolic or small vessel stroke.

CONCLUSIONS

Our results provide strong evidence supporting a possible causal association between insomnia and CVD risk. Strategies to treat insomnia may be promising targets for preventing CVDs.

CITATION

Zhang X, Sun Y, Ye S, et al. Associations between insomnia and cardiovascular diseases: a meta-review and meta-analysis of observational and Mendelian randomization studies. J Clin Sleep Med. 2024;20(12):1975-1984.

Prevalence of subthreshold depression in older adults: A systematic review and meta-analysis

BACKGROUND

The prevalence of subthreshold depression (StD) in older adults shows considerable variation across studies. This study aimed to determine the prevalence of subthreshold depression in elderly people.

METHODS

We conducted a thorough literature search across multiple databases, including PubMed, Web of Science, Medline, Cochrane Library, SinoMed, Wan Fang Data, CNKI, and VIP. Statistical analyses were carried out using STATA version 16.0. Our study was prospectively registered with PROSPERO (CRD42023494210).

RESULTS

Seventy-seven studies involving 225,232 individuals were included in this meta-analysis. The overall prevalence of subthreshold depression was 18.6 % (95 % CI: 16.0 %-21.2 %, I2 =99.8 %, p<0.001. Subgroup analyses showed the prevalence of StD in older adults varied depending on the screening tools used and the continent of the study. Funnel plots and Egger's test did not reveal any significant publication bias (Egger's test: p = 0.057).

CONCLUSION

The prevalence of subthreshold depression in older adults is high, suggesting attention needs to be paid to the mental health of the elderly. To prevent a larger public health issue, it is imperative to implement timely and effective preventive measures and interventions, focusing on early detection and intervention.

Association of non-selective β blockers with the development of renal dysfunction in liver cirrhosis: a systematic review and meta-analysis

BACKGROUND & AIMS

Non-selective β blockers (NSBBs) may negatively influence renal function through decreasing heart rate and cardiac output. This study aimed to systematically investigate their association.

METHODS

PubMed, EMBASE, and Cochrane library databases were searched to identify all relevant studies evaluating the association of NSBBs with renal dysfunction in cirrhotic patients. Unadjusted and adjusted data were separately extracted. Odds ratios (ORs) and hazard ratios (HRs) were pooled. Subgroup meta-analyses were performed according to the proportions of ascites and Child-Pugh class B/C and the mean model for end-stage liver disease (MELD) score. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS

Fourteen studies were finally included. Based on unadjusted data, NSBBs significantly increased the risk of developing renal dysfunction (OR = 1.49; p = 0.03), and this association remained significant in subgroup analyses of studies where the proportions of ascites was >70% and Child-Pugh class B/C was 100%. Based on adjusted data with propensity score matching (adjusted OR = 0.61; p = 0.08) and multivariable regression modelling (adjusted HR = 0.86; p = 0.713), NSBBs did not increase the risk of developing renal dysfunction, and this association remained not significant in subgroup analyses of studies where the proportions of ascites was >70% and <70%, the proportion of Child-Pugh class B/C was <100%, and the mean MELD score was <15. The quality of evidence was very low for all meta-analyses.

CONCLUSIONS

NSBBs may not be associated with the development of renal dysfunction in liver cirrhosis. However, more evidence is required to clarify their association in specific populations.

Influence of Humeral Component Cement and Bone Grafting on Greater Tuberosity Healing and Functional Outcomes After Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: A Systematic Review and Meta-Analysis

BACKGROUND

Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of displaced proximal humerus fractures (PHFs) with reliable clinical improvement. However, the preferred techniques for humeral stem fixation are varied and may be influenced by patient and injury characteristics, including bone quality and fracture pattern. This systematic review and meta-analysis sought to determine the effect of humeral component cementing and bone grafting on tuberosity healing rates and functional outcomes after RSA for PHFs.

METHODS

A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for clinical studies on RSA performed for PHFs that reported on the use of cemented humeral stems and autograft bone. The primary outcome was the rate of greater tuberosity healing between the various techniques. Secondarily, the authors compared clinical outcomes including postoperative external rotation, forward elevation, abduction, Constant score, and the incidence of complications and revision surgery. Outcomes were compared based on the use of an uncemented press-fit stem, a fully cemented stem without bone graft, or a partially cemented stem with humeral head autograft (i.e., black and tan technique).

RESULTS

Forty-eight studies reporting on 1,797 RSAs were included (mean patient age, 75 years; follow-up, 34 months; 81% female). Tuberosity healing was highest in the uncemented cohort, then the black and tan cohort, and lowest in the cemented cohort (80% vs. 70% vs. 61%, p = 0.006). No significant differences in postoperative range of motion, Constant score, complication rates, or revision rates were found.

CONCLUSION

Uncemented fixation with a press-fit stem was associated with superior greater tuberosity healing rates; however, functional outcomes and complications did not differ among techniques.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Efficacy and safety of radiofrequency ablation for secondary hyperparathyroidism: a systematic review and meta-analysis

Background

Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) that affects approximately 90% of end-stage renal disease and poses a significant threat to long-term survival and quality of life in patients.

Objectives

To assess whether radiofrequency ablation (RFA) is a productive and low-risk treatment for hyperparathyroidism secondary to CKD.

Methods

Embase, Web of Science, Cochrane Library, and PubMed were searched independently by two authors. The results after RFA and baseline biochemical indicators were compared, and parathyroid hormone (PTH), serum calcium, and serum phosphorus levels were the major outcomes.

Results

Four retrospective studies were screened out from 147 original literature and involved 118 cases. After RFA, serum PTH levels (1 d standardized mean difference [SMD] = -2.30, 95% confidence interval [CI] = from -3.04 to -1.56, P < 0.0001; 6 months SMD = -2.15, 95% CI = from -3.04 to -1.26, P < 0.0001; 12 months SMD = -2.35, 95% CI = from -3.52 to -1.17, P < 0.0001), serum calcium levels (1 d SMD = -1.49, 95% CI = from -2.18 to -0.81, P = 0.0001; 6 months SMD = -1.09, 95% CI = from -1.51 to -0.68, P < 0.0001), and serum phosphorus levels (1 d SMD = -1.37, 95% CI = from -1.67 to -1.07, P < 0.0001; 6 months SMD = -1.06, 95% CI = from -1.35 to -0.78, P < 0.0001) decreased significantly.

Conclusions

RFA, the newest thermal ablation technique, can effectively and safely treat hyperparathyroidism secondary to CKD. Hoarseness is the most common complication but is reversed within 6 months.

Genetic insights into litter size in goats: A meta-analysis of KISS1 and BMP15 SNP variants

Litter size is a key trait in livestock breeding. The BMP15 and KISS1 genes have been studied in goats, but results on their association with litter size are inconsistent. The objective of this study was to employ a meta-analysis approach to investigate the genetic relationship between the BMP15 (g.735 G>A) and KISS1 (g.2540 C>T and g.2510 G>A) genes and litter size in goats. A total of five studies (including 12 breeds) were included for the g.735 G>A mutation, three studies (including nine breeds) for g.2540 C>T, and two studies (including six breeds) for g.2510 G>A in this meta-analysis. The meta-analysis was conducted under four different genetic models: recessive (GG + AG vs. AA), dominant (GG vs. AG + AA), additive (GG vs. AA) and codominant (GG + AA vs. AG) models of inheritance. Data were analyzed under either random or fixed effects models based on the estimates of I2 estimates. A sensitivity analysis was performed by removing one study at a time to determine the stability of the overall results. Funnel plots and the Egger regression tests were also used to assess the publication bias among studies. Significant associations (P< 0.05) were observed between the g.2540 C>T and g.2510 G>A loci and litter size in goats under the additive (SMD = -0.469, 95 % CI = -0.908 to -0.030, P-value = 0.036) and codominant (SMD = 0.147, 95 % CI = 0.003-0.291, P = 0.046) genetic models, respectively. Our results did not identify any significant association between g.735 G>A of BMP15 and litter size under the investigated genetic models.

Outcomes of lateralized reverse total shoulder arthroplasty versus latissimus dorsi transfer for external rotation deficit: a systematic review and meta-analysis

BACKGROUND

To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER).

METHODS

We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications.

RESULTS

We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was -14°, while mean preoperative ER in lateralized RSA alone was -11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone.

CONCLUSIONS

Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss. Level of evidence: IV.

The prevalence and risk factors of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

BACKGROUND

Interstitial lung disease (ILD) is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). Existing knowledge on the prevalence and risk factors of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is inconclusive. Therefore, we designed this review to address this gap.

MATERIALS AND METHODS

To find relevant observational studies discussing the prevalence and/or risk factors of RA-ILD, EMBASE, Web of Science, PubMed, and the Cochrane Library were explored. The pooled odds ratios (ORs) / hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with a fixed/ random effects model. While subgroup analysis, meta-regression analysis and sensitivity analysis were carried out to determine the sources of heterogeneity, the I2 statistic was utilized to assess between-studies heterogeneity. Funnel plots and Egger's test were employed to assess publication bias. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, our review was conducted.

RESULTS

A total of 56 studies with 11,851 RA-ILD patients were included in this meta-analysis. The pooled prevalence of RA-ILD was 18.7% (95% CI 15.8-21.6) with significant heterogeneity (I2 = 96.4%). The prevalence of RA-ILD was found to be more likely as a result of several identified factors, including male sex (ORs = 1.92 95% CI 1.70-2.16), older age (WMDs = 6.89, 95% CI 3.10-10.67), having a smoking history (ORs =1.91, 95% CI 1.48-2.47), pulmonary comorbidities predicted (HRs = 2.08, 95% CI 1.89-2.30), longer RA duration (ORs = 1.03, 95% CI 1.01-1.05), older age of RA onset (WMDs =4.46, 95% CI 0.63-8.29), positive RF (HRs = 1.15, 95%CI 0.75-1.77; ORs = 2.11, 95%CI 1.65-2.68), positive ACPA (ORs = 2.11, 95%CI 1.65-2.68), higher ESR (ORs = 1.008, 95%CI 1.002-1.014), moderate and high DAS28 (≥3.2) (ORs = 1.87, 95%CI 1.36-2.58), rheumatoid nodules (ORs = 1.87, 95% CI 1.18-2.98), LEF use (ORs = 1.42, 95%CI 1.08-1.87) and steroid use (HRs= 1.70, 1.13-2.55). The use of biological agents was a protective factor (HRs = 0.77, 95% CI 0.69-0.87).

CONCLUSION(S)

The pooled prevalence of RA-ILD in our study was approximately 18.7%. Furthermore, we identified 13 risk factors for RA-ILD, including male sex, older age, having a smoking history, pulmonary comorbidities, older age of RA onset, longer RA duration, positive RF, positive ACPA, higher ESR, moderate and high DAS28 (≥3.2), rheumatoid nodules, LEF use and steroid use. Additionally, biological agents use was a protective factor.

Prenatal cannabis exposure and the risk for neuropsychiatric anomalies in the offspring: a systematic review and meta-analysis

OBJECTIVE

To evaluate the association between cannabis use during pregnancy and the risk for long-term neuropsychiatric pathology in the offspring.

DATA SOURCES

MEDLINE, EMBASE, and Cochrane library databases were systematically searched until January 22, 2024, with no language or date restrictions.

STUDY ELIGIBILITY CRITERIA

Studies were eligible for inclusion if they reported quantitative data on any long-term neuropsychiatric outcome in offspring whose mothers used cannabis during pregnancy for medical or recreational use, by any route and at any trimester, in comparison to offspring of women who abstained from cannabis use during pregnancy. All observational study designs were included in the analysis.

STUDY APPRAISAL AND SYNTHESIS METHODS

A systematic review and meta-analysis were performed according to the PRISMA and MOOSE guidelines. The data was extracted independently by 2 reviewers. The following offspring outcomes were of interest: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, anxiety, psychotic disorders, as well as cannabis and other substance use. Odds ratios (OR) and 95% confidence intervals (CI) were pooled for each neuropsychiatric outcome in the offspring of women exposed to cannabis during pregnancy compared with nonexposed. Data were pooled using random-effects models.

RESULTS

Eighteen eligible observational studies were included in the systematic review, and 17 were included in the final quantitative analysis, representing 534,445 participants. After adjusting for confounders, the pooled OR for ADHD was 1.13 (95% CI 1.01-1.26); for ASD, the pooled OR was 1.04 (95% CI 0.74-1.46); for psychotic symptoms, the pooled OR was 1.29 (95% CI 0.97-1.72); for anxiety, the pooled OR was 1.34 (95% CI 0.79-2.29); for depression, the pooled OR was 0.72 (95% CI 0.11-4.57); and for offspring's cannabis use, the pooled OR was 1.20 (95% CI 1.01-1.42).

CONCLUSION

Prenatal cannabis exposure is not associated with an increased risk of ASD, psychotic symptoms, anxiety, or depression in offspring. However, it may slightly elevate the risk of ADHD and predispose offspring to cannabis consumption. Despite these findings, caution is warranted regarding cannabis use during pregnancy. Further research is imperative, especially given the increasing potency of cannabis in recent years.

Mindfulness-based psychosocial interventions and psychological wellbeing in cancer survivorship: a meta-analysis

PURPOSE

Among cancer survivors, mindfulness-based interventions appear promising in decreasing distress for cancer patients, but little attention has been paid to the ultimate mindfulness goal of increasing psychological wellbeing. This meta-analysis aims to summarise and synthesise available evidence concerning the effectiveness of MBIs on positive psychological outcomes reflecting key aspects of psychological wellbeing in heterogeneous cancer patients.

METHODS

A literature search of mindfulness-based randomised clinical trials in cancer survivors was conducted across six electronic databases. Two reviewers independently screened studies and extracted data. Meta-analyses were conducted using R; standardised mean difference (SMD) was used to determine intervention effect. Moderators examined included therapeutic orientation, control group type, treatment modality, treatment target, heterogeneous vs. homogeneous cancer type, and facet of wellbeing.

RESULTS

Thirty-one studies were included (N = 2651). Those who received mindfulness-based interventions reported significantly higher eudaimonic, hedonic, and social wellbeing than respondents in control groups (SMD = 0.599). Interventions were equally effective across therapeutic orientation, control group type, treatment modality and treatment target. There were trend level differences favouring homogeneous cancer diagnosis groups over heterogeneous diagnosis groups.

CONCLUSION

MBIs provide an effective treatment for increasing psychological wellbeing in cancer survivors. This finding has important implications for clinical practice.

COVID-19 outcomes among patients with sickle cell disease or sickle cell trait compared to the general population: a systematic review and meta-analyses

Individuals with sickle cell disease (SCD) and sickle cell trait (SCT) face an increased risk of complications from COVID-19 due to their susceptibility to infections and venous thromboembolism. We selected 28 studies from 3228 references in bibliographic databases to compare COVID-19 outcomes (hospitalization, ICU admission, need for ventilatory support, thromboembolic events, and mortality) between patients with SCD or SCT and control patients. Compared to control patients, the pooled risk of hospitalization was not significantly higher in those with SCT (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.94-1.34) but the pooled risk of death was higher (OR 1.43, 95% CI 1.14-1.78). Compared to controls patients, those with SCD had a much higher pooled risk of hospitalization (OR 7.79, 95% CI 5.13-11.81) and a non-different risk of death once hospitalized (OR 0.82, 95% CI 0.62-1.10), resulting in an overall increased risk of death (OR 1.94, 95% CI 1.26-2.98).

Effectiveness of smartphone app-based interventions after surgery on quality of recovery among cancer patients: a systematic review and meta-analysis

BACKGROUND

Postoperative recovery in patients with cancer is a complex process that influences quality of life, functional recovery, and mental well-being. Smartphone app-based interventions have emerged as potential tools for improving various aspects of health and well-being in cancer patients. However, the existing literature lacks a consensus on the efficacy of these interventions, leading to conflicting outcomes.

METHODS

We searched multiple databases, including PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, and MEDLINE Complete (EBSCO). We exclusively selected randomized controlled trials meeting the inclusion criteria for our systematic review and meta-analysis. Utilizing a random-effects model, we derived the pooled effect size estimates for the meta-analysis. Where applicable, we calculated the pooled standardized mean difference (SMD) with 95% confidence interval (CI). The Cochrane Collaboration tool (Cochrane ROB) was used to evaluate bias in randomized trials. The primary outcome was the quality of life. The secondary outcomes were psychological symptoms, health conditions, satisfaction, and self-efficacy.

RESULTS

Of 731 screened articles, 15 were included, comprising 1,831 participants. Our meta-analysis revealed that app-based interventions potentially improved quality of life (SMD =  -0.58, 95% CI -1.00 to -0.16), alleviated psychological symptoms (SMD =  -0.43, 95% CI -0.72,-0.15; p = .003), and enhanced self-efficacy (SMD = 0.90, 95% CI 0.26 to 1.53; p  =  0.001). However, there was no statistically significant effect on satisfaction (SMD = 1.25, 95% CI-1.06 to 3.57; p  =  0.23).

CONCLUSIONS

Our findings suggest that mobile health apps hold promise in improving the well-being of cancer patients after surgery by enhancing their quality of life, health status, and self-efficacy, while also reducing anxiety and depression.

Effect of antibiotic growth promoters (AGPs) on feed conversion ratio (FCR) of broiler chickens: A meta-analysis

Antibiotics have been used for a long time as growth promoters in the poultry industry for growth and health benefits. However, recent studies reflected little, no, or negative impacts of using antibiotics for growth promotion purposes. This study was designed to examine the overall effect of antibiotic supplementation on the feed conversion ratio (FCR) in broiler chickens as a performance indicator and assess different covariates for explaining heterogeneity in response to the use of antibiotics as growth promoters. In this regard, FCRs obtained from articles that compared diets with and without antibiotics for broiler chickens were extracted from electronic databases (PubMed, Web of Science, and Google Scholar) as per PRISMA guidelines. The database comprised 42 scientific articles containing 74 experiments totaling 19,562 chickens. A basic meta-analysis and subgroup analysis were performed to assess the overall impact of antibiotic growth promoters (AGPs) on FCR of broiler chickens while a meta-regression analysis was used to assess different covariates (breed, antibiotic dose, location, time, presence of anticoccidial in the feed, antibiotic type, and housing type) to explain variations in true effect size of the studies. The basic meta-analysis of these studies revealed an overall improvement in FCR by 2.8 % (p < 0.05) due to addition of AGPs than the control group with the confidence interval range from 1.3 to 4.3 % and the prediction interval ranging between -10 and 16 %. The covariates, including breed, dose and location, provided the optimum model fit and explained 53 % of variations in the FCR across different studies. In summary, an overall marginal improvement has been observed in mean FCR of broiler chickens along with a wide range of variations in response to use of AGPs. The variations in true effects among these studies are subject to several confounding effects, particularly breed, dose and location. Considering the marginal positive effect of antibiotic usage in chicken performance, we recommend against using of AGP.

Altered Corticospinal and Intracortical Excitability After Stroke: A Systematic Review With Meta-Analysis

BACKGROUND

Intracortical inhibitory/faciliatory measures are affected after stroke; however, the evidence is conflicting.

OBJECTIVE

This meta-analysis aimed to investigate the changes in motor threshold (MT), motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF), and identify sources of study variability using a machine learning approach.

METHODS

We identified studies that objectively evaluated corticospinal excitability and intracortical inhibition/facilitation after stroke using transcranial magnetic stimulation. Pooled within- (ie, affected hemisphere [AH] vs unaffected hemisphere [UH]) and between-subjects (ie, AH and UH vs Control) standardized mean differences were computed. Decision trees determined which factors accurately predicted studies that showed alterations in corticospinal excitability and intracortical inhibition/facilitation.

RESULTS

A total of 35 studies (625 stroke patients and 328 healthy controls) were included. MT was significantly increased and MEP was significantly decreased (ie, reduced excitability) in the AH when compared with the UH and Control (P < .01). SICI was increased (ie, reduced inhibition) for the AH when compared with the UH, and for the AH and UH when compared with Control (P < .001). ICF was significantly increased (ie, increased facilitation) in the AH when compared with UH (P = .016) and decreased in UH when compared with Control (P < 0.001). Decision trees indicated that demographic and methodological factors accurately predicted (73%-86%) studies that showed alterations in corticospinal and intracortical excitability measures.

CONCLUSIONS

The findings indicate that stroke alters corticospinal and intracortical excitability measures. Alterations in SICI and ICF may reflect disinhibition of the motor cortex after stroke, which is contrary to the notion that stroke increases inhibition of the affected side.

HIV-related outcomes among migrants living in Europe compared with the general population: a systematic review and meta-analysis

BACKGROUND

Compared with the general population, international migrants arriving in Europe face severe socioeconomic challenges that result in higher HIV prevalence and limited access to health care, potentially leading to negative outcomes. In this systematic review and meta-analysis, we aimed to investigate the incidence of HIV-related outcomes among international migrants arriving in Europe compared with the incidence among the general population.

METHODS

We did a systematic review and meta-analysis to identify studies investigating HIV-related outcomes in migrants and the general population living with HIV in Europe. Six authors (EDV, VP, VS, SDG, MC, and RN) independently searched PubMed, Scopus, and Web of Science from database inception until July 22, 2023 (with an update on March 3, 2024), then screened titles and abstracts of all potentially eligible articles. Studies were included if they were observational studies; investigated clinical, virological, or immunological outcomes in migrants living with HIV; were conducted in Europe; had at least one control group of non-migrants living in a European country; and were in English. Titles and abstracts were screened for eligibility followed by a full-text assessment by two authors (EDV, VP, VS, SDG, MC, or RN). Data were extracted from articles using a structured Redcap form. Primary outcomes of our systematic review were (1) mortality, (2) AIDS-defining condition, (3) combined outcome of AIDS or death, (4) treatment discontinuation, (5) rate of loss to follow-up, (6) virological failure, and (7) immunological failure. Data were reported as relative risks (RRs) or odds ratios with their 95% CIs. The study is registered with PROSPERO, CRD42024501191.

FINDINGS

Of the 1316 articles identified (1297 in the initial search and 19 in the updated search), 19 were included in our systematic review, consisting of 104 676 participants who were followed up for a mean of 79·3 months. The meta-analysis, adjusted for potential confounders, showed that migrants present similar mortality risk (RR 0·88, 95% CI 0·75-1·04), but higher risk for AIDS-defining conditions (1·23, 1·14-1·34), treatment discontinuation (2·39, 1·49-3·29), loss to follow-up (2·53, 1·41-4·53), virological failure (1·80, 1·25-2·60), and immunological failure (3·70, 2·17-12·50) compared with the general population. In subanalyses for WHO regions, people originally from the African region had higher risk for HIV-related adverse outcomes.

INTERPRETATION

Compared with the non-migrant population, migrants living in Europe with HIV face higher risks for progression to AIDS, loss to follow-up, treatment discontinuation, and virological and immunological failure. Interventions aimed to improve HIV care among migrants living in Europe are urgently needed.

FUNDING

None.

Impact of CYP2C19 Genotype on Efficacy and Safety of Clopidogrel-based Antiplatelet Therapy in Stroke or Transient Ischemic Attack Patients: An Updated Systematic Review and Meta-analysis of Non-East Asian Studies

PURPOSE

Inconclusive and limited results have been reported on the clinical utility of CYP2C19 genotyping in stroke/TIA patients of non-East Asian ancestries. We herein performed an updated systematic review and meta-analysis to quantitatively estimate the association of CYP2C19 loss-of function (LOF) status with efficacy and safety of clopidogrel-based antiplatelet therapy in non-East Asian patients affected by stroke or TIA.

METHODS

A comprehensive search was performed up to July 2023 using PubMed, Web of Knowledge, and Cochrane Library databases. The clinical outcomes investigated were stroke, composite vascular events and bleeding. Pooled estimates were calculated as risk ratios (RR) with 95% CI using the Mantel- Haenszel random-effects model. The quality of evidence was assessed using the GRADEpro tool.

RESULTS

A total number of 1673 stroke/TIA patients from 8 non-East Asian studies, published between 2014 and 2022, were included in the systematic review. Clopidogrel-treated carriers of CYP2C19 LOF alleles were found at increased risk of stroke compared to non-carriers (RR: 1.68, 95%CI: 1.04-2.71, P = 0.03). However, no significant association was observed with the risk of composite vascular events (RR: 1.15, 95%CI: 0.58-2.28, P = 0.69) or bleeding (RR: 0.84, 95%CI: 0.38-1.86, P = 0.67). Similarly, European ancestry patients carrying CYP2C19 LOF alleles displayed a higher risk of stroke (RR: 2.69 (1.11-6.51, P = 0.03), but not of composite vascular events or bleeding.

CONCLUSION

The present updated meta-analysis provides moderate quality evidence of association between CYP2C19 LOF alleles and an increased risk of stroke in non-East Asian patients with stroke/TIA after receiving clopidogrel therapy. Further large pharmacogenetic studies are still warranted to corroborate these findings.

The association between school bullying and executive functions in children and adolescents: A three-level meta-analysis

INTRODUCTION

Even though existing amounts of results have shown that school bullying could be related to the main components of executive functions (EFs) (inhibitory control, working memory, and cognitive flexibility), research focused on this association yields inconsistent results.

METHOD

To address this research gap, the current study conducted a three-level meta-analysis approach and simultaneously considered the two perspectives of the bully and victim to clarify the relationship between school bullying experienced by children and EFs. It also explored the moderating variables that affect the relationship between school bullying and EFs.

RESULTS

Based on 18 studies reporting 73 effect sizes (N = 21,725), the results revealed that the overall effect size for the association between both the bullies and victims of school bullying incidents with EFs (rbullies = -0.154, p < .05; rvictims = -0.187, p < .001). Moderator analyses revealed that the negative correlation between bullies of school bullying and EFs was moderated by EF components, but it was not affected by gender, age, and the EF measurement method. Moreover, the negative correlation between victims of school bullying and EFs was not affected by the form of bullying, source of report, facet of EFs, EF measurement, gender, age, and culture.

CONCLUSIONS

The present meta-analysis revealed a relationship between school bullying and EFs. Both bullies and victims appear to have lower EF levels. The results also emphasized that lower inhibitory control was more likely to be a crucial risk factor for bullying behavior.